Bearing the burden of the uphill battle against childhood obesity

In recent years, childhood overweight and obesity statistics have received a good deal of media attention, but this has done little to slow their rise. Data from the National Health and Nutrition Examination Survey shows that nearly 1 in 5 children aged 2-19 are obese. Even more concerning, since 1980 obesity rates have tripled in the 6-11 and 12-19 age groups.

Our individualistic society has decided that obesity is a personal failure – something that’s completely the fault (and under the control) of the patient – but it’s not as simple a decision to smoke a cigarette, drive drunk, or get on a motorcycle without a helmet. Obesity is multifactorial, and this fact is only highlighted when dealing with pediatric patients, but the advice we give is two-dimensional: eat less, exercise more.

Unfortunately, we’ve been giving more or less this same advice for decades as the problem continues to worsen. There is accumulating research that obesity causes potentially irreversible metabolic alterations that render our mantra of “diet and exercise” inadequate to reverse the problem. Thus, some would argue that the best way to address the obesity epidemic in America is to prevent obesity in the first place – but in order to do this, we have to understand how we got here.

Contributing to the obesity issue is the fact that we’ve drastically changed the very notion of what it means to feed ourselves: at the grocery store we buy meals, entrees, and side dishes – not ingredients. Worse, the food & diet industries actively work to confuse consumers through marketing and product placement. Sedentary entertainment has vastly expanded in the past several decades, and in many communities, such as the one I currently serve, children have even less opportunities to exercise because their schools have cut gym class or it’s just plain unsafe to go outside. These variables result in obesity being practically inevitable – “the new default,” as one of the physicians I work with recently called it.

So what are doctors doing about it? Research shows that we’re doing a poor job of talking to children and their parents about unhealthy weights – one study revealed that among parents of children with a BMI in the 85th percentile or higher (the numerical definition of overweight in children), only 22% report being told by a doctor or other health professional that their child was overweight. Assuming we even decide to address the issue, we have to give children and their parents a clear message and help them set real goals – I cringe when I see doctors tell parents “Johnny just has to try to eat a little less, and get a bit more exercise.”

Two of the biggest offenders I’ve been able to detect when interviewing children and their parents are liquid calories and portion size, but it’s important not to overwhelm patients when asking them to make lifestyle changes. Therefore, my strongest recommendation to parents is often to limit juices and eliminate sweetened drinks – especially sports drinks and sodas. I’m not a fan of artificially sweetened drinks or “diet” beverages, but in medicine we often have to bargain with patients, and I’d rather see children drinking flavored water than Coke and Gatorade. However, I’d caution parents to consider the impact that training their children to drink only that which is sweet will have on their health in the future.

But things like limiting sugar and teaching portion control are just the tip of the iceberg. We won’t make substantial inroads in reigning in childhood obesity until we attack the problem on multiple fronts. That means improving school lunches, eliminating food desserts, making neighborhoods more exercise-friendly, and plenty of other small changes that, when combined, alter the environment we expose our children to – and this can only happen when we decide as a society that these are the right things to do. Until then, parents and doctors will continue to bear the burden of the uphill battle against childhood obesity.

Bearing the burden of the uphill battle against childhood obesity 4 comments

insulin is what drives fat into storage. What drives insulin up? Carbohydrates. Not meat and fat.

ilonahb

James,

I agree with you. I would put great efforts into prevention (meant education). I would start with education of young parents, expecting mothers. They have to learn the basics of healthy living (eating, exercising) to be able to build healthy habits in their children. If you observe more closely ( I am sure you did) frequently obese children have obese parents. If you glance at their shopping cart at teh grocery store I am sure you would want to scream. BUT, look at the price of the groceries. The “wonderbread” is the cheapest one. I think you can buy a loaf for a $1 or less. Can you argue for a sprouted, multigrain bread for the cost of $5-6 a loaf? Just one of the examples. The problem needs multifactorial approach ASAP. Childhood obesity is a huge problem and it will be a huge burden for a healthcare, with all the complications of it. I think investing into prevention is the best way to go. Prevention needs joint efforts.

Read Ellyn Satter; when you graduate from high school, you should get a copy of her book. She brings some much needed common sense in the discussion about how to feed ourselves and how to learn to enjoy a wide variety of food.

My parents were completely obsessed with my weight and my entire childhood was feast or famine. And trust me, it didn’t make me thin, it just made me miserable and destroyed my ability to actually judge when I’m full. Now I’m really fat.

When forced to diet from birth, actually for me it was in the womb, healthy food and exercise becomes punishment for being fat and not something I want to do because it actually makes me feel good.

I highly suggest checking out the Feeding Doctor blog.

(I have no stake in Ellyn Satter or the Feeding Doctor blog, other than the fact they have helped me personally.)

One issue to consider is the role of short sleep in obesity in children and adults. There are tons of articles on this. I wrote an article on it here.
http://drcraigcanapari.com/2012/04/03/lack-of-sleep-may-make-kids-obese/